Basic Information
| Provider Information | |||||||||
| NPI: | 1013976687 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SYED | ||||||||
| FirstName: | GAFFAR | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 TOLL HOUSE AVE | ||||||||
| Address2: | SUITE H4 | ||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217014564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016989444 | ||||||||
| FaxNumber: | 3016954444 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 TOLL HOUSE AVE | ||||||||
| Address2: | H4 | ||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217014564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016989444 | ||||||||
| FaxNumber: | 3016954444 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2006 | ||||||||
| LastUpdateDate: | 06/28/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D0061410 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00209291 | 01 | MD | RAILROAD | OTHER | 64353004 | 01 | MD | BCBS OF MD | OTHER | 001182700 | 05 | MD | MEDICAID |